A Nurse-Led Approach to Preventing Delirium in the ICU: A Randomised Controlled Trial of NICE Guideline-Based Sensory Modulation

Abstract

Background Delirium is a preventable yet pervasive complication in intensive care units (ICUs) settings, disproportionately increasing patient morbidity and healthcare costs. While environmental disruptions (e.g., light/noise) are modifiable risk factors, nurse-delivered, non-pharmacological strategies may be under-implemented in routine practice despite guideline recommendations.Aim This study aimed to evaluate the efficacy of a simple, holistic nursing intervention-eye masks and earplugs-to mitigate delirium incidence in ICU patients.Study Design A randomised controlled trial was conducted in the adult general intensive care unit of a public hospital in Istanbul, Türkiye, between May and September 2024. Patients were assigned to either an intervention group (nightly use of eye masks and earplugs together with a delirium prevention guide) or a control group (delirium prevention guide only). Delirium was assessed using the Richmond Agitation Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC).Results In total, 190 patients were randomised. Ten participants allocated to the intervention group did not receive the intervention because 9 were unwilling to continue and 1 became intubated. Consequently, 180 patients were analysed (90 per group). The intervention group showed a 62% lower incidence of delirium than the control group (7.8% vs. 20%, p = 0.001). In addition, delirium developed later in the intervention group (2.57 +/- 0.79 vs. 1.89 +/- 0.85 days, p = 0.001), and Nu-DESC scores differed significantly between the groups (p = 0.001).Conclusions Nightly use of eye masks and earplugs was associated with lower delirium incidence and later onset in ICU patients when implemented alongside a NICE-aligned delirium prevention guide.Relevance to Clinical Practice As a scalable, non-pharmacological approach, this intervention offers a feasible, low-cost option that empowers nurses to lead delirium prevention through holistic, patient-centred care. Further studies may help clarify generalisability across different ICU settings.Trial Registration ClinicalTrials.gov ID: NCT06403410